Unverricht-Lundborg Disease: Tackling the Challenges of a Complex Clinical Picture

Authors

  • Mafalda Ferreira dos Santos Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Pediatrics Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
  • Mário Laço Medical Genetics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
  • Conceição Robalo Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Filipe Palavra Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Laboratory of Pharmacology and Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal https://orcid.org/0000-0002-2165-130X

DOI:

https://doi.org/10.46531/sinapse/CC/220078/2023

Keywords:

Child, Unverricht-Lundborg Syndrome

Abstract

Unverricht-Lundborg disease (ULD), also called progressive myoclonic epilepsy type 1, is characterized by stimulus-induced myoclonus and seizures without major progressive cognitive deficit, usually presenting during late childhood and early adolescence. It is an autosomal recessive disease, and, so far, only pathogenic variants in the gene encoding cystatin B (CSTB) have been described. We report the case of a 9-year-old boy who presented with generalized tonic-clonic seizures and developed paroxysmal myoclonic events over several years. The patient was started on antiseizure medication, but disease progression resulted in several changes to the therapeutic scheme, with highly variable clinical responses. The genetic study detected the pathogenic variant c.67-1G>C p.(?) in heterozygosity in the CSTB gene, after having identified the typical dodecameric expansion in the other allele, confirming the diagnosis of ULD.

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References

Knupp K, Wirrell E. Progressive myoclonic epilepsies – It takes a village to make a diagnosis. Neurology. 2014;82:378379. doi: 10.1212/WNL.0000000000000091

Hosny H, El Tamawy M, Gouider R, Lesca G, Abdel Naseer M, Kishk N, et al. Clinical and molecular characterization of Unverricht-Lundborg disease among Egyptian patients. Epilepsy Res. 2021;176:106746. doi: 10.1016/j.eplepsyres.2021.106746.

de Haan GJ, Halley DJ, Doelman JC, Geesink HH, Augustijn PB, Jager-Jongkind AD, et al. Univerricht-Lundborg disease: underdiagnosed in the Netherlands. Epilepsia. 2004;45:1061-3. doi: 10.1111/j.0013-9580.2004.43703.x.

Kälviäinen R, Khyuppenen J, Koskenkorva P, Eriksson K, Vanninen R, Mervaala E. Clinical picture of EPM1-Unverricht-Lundborg disease. Epilepsia. 2008;49:549-56. doi:10.1111/j.1528-1167.2008.01546.x.

Lasek-Bal A, Lukasik M, Zak A, Sulek A, Bosak M. Unverricht-Lundborg disease: Clinical course and seizure management based on the experience of polish centers. Seizure. 2019;69:87-91. doi: 10.1016/j.seizure.2019.04.008.

Holmes GL. Drug Treatment of Progressive Myoclonic Epilepsy. Paediatr Drugs. 2020;22:149-64. doi: 10.1007/s40272-019-00378-y.

Hyppönen J, Äikiä M, Joensuu T, Julkunen P, Danner N, Koskenkorva P, et al. Refining the phenotype of Unverricht-Lundborg disease (EPM1): a population-wide Finnish study. Neurology. 2015;84:1529-36. doi: 10.1212/WNL.0000000000001466.

Magaudda A, Ferlazzo E, Nguyen VH, Genton P. UnverrichtLundborg disease, a condition with self-limited progression: long-term follow-up of 20 patients. Epilepsia. 2006;47:8606. doi: 10.1111/j.1528-1167.2006.00553.x.

Lalioti MD, Scott HS, Genton P, Grid D, Ouazzani R, M’Rabet A, et al. A PCR amplification method reveals instability of the dodecamer repeat in progressive myoclonus epilepsy (EPM1) and no correlation between the size of the repeat and age at onset. Am J Hum Genet. 1998;62:842-7. doi: 10.1086/301798.

Kyllerman M, Sommerfelt K, Hedström A, Wennergren G, Holmgren D. Clinical and neurophysiological development of Unverricht-Lundborg disease in four Swedish siblings. Epilepsia. 1991;32:900-9. doi: 10.1111/j.1528-1157.1991.tb05549.x.

Mohamadpour M, Gabriel G, Grant AC. A Native Haitian Woman with Unverricht-Lundborg Disease. Case Rep Neurol. 2017;9:284-8. doi: 10.1159/000484136.

Genton P, Delgado Escueta A, Serratosa JM, Michelucci R, Bureau M. Progressive myoclonus epilepsies. In: Bureau M, Genton P, Delgado Escueta A, Dravet C, Tassinari CA, Thomas , et al, editors. Epileptic Syndromes in Infancy, Childhood and Adolescence. 5th ed. London: John Libbey Eurotext Ltd; 2012. p.575-606.

Segal E, Vendrame M, Gregas M, Loddenkemper T, Kothare SV. Effect of treatment of obstructive sleep apnea on seizure outcomes in children with epilepsy. Pediatr Neurol. 2012;46:359-62. doi: 10.1016/j.pediatrneurol.2012.03.005.

Lanzone J, Ricci L, Tombini M, Boscarino M, Mecarelli O, Pulitano P, et al. The effect of Perampanel on EEG spectral power and connectivity in patients with focal epilepsy. Clin Neurophysiol. 2021;132:2176-83. doi: 10.1016/j.clinph.2021.05.026.

Crespel A, Ferlazzo E, Franceschetti S, Genton P, Gouider R, Kälviäinen R, et al. Unverricht-Lundborg disease. Epileptic Disord. 2016;18:28-37. doi: 10.1684/epd.2016.0841.

Edwards MJ, Hargreaves IP, Heales SJR, Jones SJ, Ramachandran V, Bhatia KP, et al. N-acetylcysteine and Unverricht-Lundborg disease: variable response and possible side effects. Neurology. 2002;59:1447-9. doi: 10.1212/wnl.59.9.1447.

Tallarico M, Leo A, Guarnieri L, Zito MC, De Caro C, Nicoletti F, et al. N-acetylcysteine aggravates seizures while improving depressive-like and cognitive impairment comorbidities in the WAG/Rij rat model of absence epilepsy. Mol Neurobiol. 2022;59:2702-14. doi: 10.1007/s12035-02102720-3.

Smith B, Shatz R, Elisevich K, Bespalova IN, Burmeister M. Effects of vagus nerve stimulation on progressive myoclonus epilepsy of Unverricht-Lundborg type. Epilepsia. 2000;41:1046-8. doi: 10.1111/j.1528-1157.2000.tb00293.x.

Khiari HM, Franceschetti S, Jovic N, Mrabet A, Genton P. Death in Unverricht-Lundborg disease. Neurol Sci. 2009;30:315-8. doi: 10.1007/s10072-009-0102-2.

Franceschetti S, Michelucci R, Canafoglia L, Striano P, Gambardella A, Magaudda A, et al. Progressive myoclonic epilepsies: definitive and still undetermined causes. Neurology. 2014;82:405-11. doi: 10.1212/WNL.0000000000000077.

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Published

2024-01-27

How to Cite

1.
Ferreira dos Santos M, Laço M, Robalo C, Palavra F. Unverricht-Lundborg Disease: Tackling the Challenges of a Complex Clinical Picture. Sinapse [Internet]. 2024 Jan. 27 [cited 2024 Nov. 23];23(4):217-22. Available from: https://sinapse.pt/index.php/journal/article/view/7